Frequently asked questions about reimbursement from citizens
Questions about single reimbursement
Questions about reimbursement for the chronically ill
Question about reimbursement for the terminally ill
Question
How long is a single reimbursement valid?
Answer
Single reimbursement is usually not subject to any time limit. This means that the doctor does not have to reapply for these kinds of individual reimbursement. If the medicinal product, which the single reimbursement is for, becomes eligible for general (= automatic) reimbursement, the single reimbursement becomes invalid because it will then be superfluous.´
Question
I have been granted single reimbursement for a medicinal product. Can I get reimbursement for any of the expenses I have had for the medicinal product before I was granted reimbursement?
Answer
Yes, if you have receipts for what you have bought, you can get reimbursement from the date when the single reimbursement enters into force. Please note that the reimbursement is calculated on the basis of the price and according to the reimbursement percentage you have on the date when you go to the pharmacy with your single reimbursement in order to have previous purchases reimbursed. If the reimbursement period has changed from the time of purchase to the time of reimbursement, you might be given less reimbursement than expected. The reason for this is that the reimbursement is calculated on the basis of your current CTR balance (CTR = Central Reimbursement Register) and thereby the percentage you are entitled to at the time of reimbursement.
Question
Are single reimbursements granted prior to 1 March 2000 still valid?
Answer
Yes, but the reimbursement percentage (e.g. 49.8% or 74.7%) indicated on single reimbursements issued prior to 1 March 2000 no longer applies. After 1 March 2000, a single reimbursement means that you will be reimbursed for the medicinal product concerned according to the new regulation and percentages.
Question
I have been granted single reimbursement. Is it possible for me to obtain reimbursement for e.g. a hepatitis B vaccine that is not bought at a pharmacy but from my doctor?
Answer
No. It is a prerequisite for using a single reimbursement that the medicinal product/vaccine, which the single reimbursement is intended for, is bought at a pharmacy and dispensed according to a prescription. The reason for this is that only pharmacies are able to report the price of the medicinal product to the Central Reimbursement Register (CTR). Among other things, the CTR keeps a track of how large a percentage of reimbursement an individual is entitled to.
Question
Does single reimbursement granted for one type of bisphosphonate (e.g. Didronate) also apply to another type of bisphosphonate (e.g. Fosamax)?
Answer
Yes.
Question
What is reimbursement for the chronically ill?
Answer
If your doctor can document that you have a large, permanent and scientifically well-documented need for medicine, he/she can apply for reimbursement for the chronically ill for you. Reimbursement for the chronically ill means that there is an upper limit to your annual expenses for medicinal products eligible for reimbursement: When you have paid DKK 3,490 within a reimbursement year, the National Health Service will pay the rest, provided that you use the least expensive of two identical products. Please note that you must buy medicinal products for more than DKK 16,131 (CTR balance) before you have paid DKK 3,490. The Danish Medicines Agency must receive an application from your doctor before the end of the reimbursement year, but in that case, it will have retroactive effect dating back to the beginning of the reimbursement year.
Question
When does reimbursement for the chronically ill enter into force?
Answer
Reimbursement for the chronically ill enters into force from the beginning of the personal reimbursement period current at the date when the reimbursement is issued. In order to use a reimbursement for the chronically ill (equal to 100% reimbursement) it is a precondition that you have bought medicine eligible for reimbursement for more than DKK 16,131 (DKK 19,888 for children under 18), which means that you have paid DKK 3,490 within one year.
Question
How long is reimbursement for the chronically ill valid?
Answer
Most reimbursements for the chronically ill are valid for 5 years from the date of entry into force. The reimbursement is valid in the reimbursement years it overlaps, i.e. from the beginning of the reimbursement year current at the date when it enters into force and to the end of the reimbursement year in which it expires. Hence, your doctor should not apply again before the date of expiry of the reimbursement is approaching.
Question
How high must my balance in the CTR be before reimbursement for the chronically ill covers all of my expenses for medicinal products eligible for reimbursement?
Answer
Your balance in the CTR must exceed DKK 16,131 for adults and DKK 19,888 for children under 18 within your personal 1-year period of reimbursement before you receive full reimbursement. The reason for this is that you will not have paid DKK 3,490 until you have purchased medicine for at least DKK 16,131. The amount DKK 16,131 is gross, i.e. before subtraction of the ordinary National Health Service reimbursement.
Question
My balance had already exceeded DKK 16,131 when I was granted reimbursement for the chronically ill. Where can I get a refund of the outstanding amount?
Answer
You can get a refund by contacting your pharmacy, which will settle with the National Health Service. The Danish Medicines Agency does not refund any expenses.
Question
I have already been granted reimbursement for the chronically ill and now I am to use a new medicinal product. Should my doctor apply again?
Answer
No. Once you have been granted reimbursement for the chronically ill, it covers all medicinal products eligible for reimbursement that you are treated with. Yet, it is a precondition that you have bought medicinal products eligible for reimbursement for more than DKK 16,131 (DKK 19,888 for children under 18), which is equivalent to you paying DKK 3,490 within one year
Question
Does reimbursement for the terminally ill also cover e.g. nutritional preparations/tube feeding formulas?
Answer
No. Reimbursement for the terminally ill, for people who choose to spend their last time at home or at a hospice instead of at hospital, exclusively covers expenses for medicinal products prescribed by a doctor. If you would like to have covered your expenses for, for instance, nutritional preparations/tube feeding formulas and remedies, you must apply to your municipality.
Danish Medicines Agency, last updated 4 January 2010
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